Home Dwelling Research Articles

Validation of a Self- Administration of Medications Assessment Tool for Home Dwelling Older Adults During an Elective Admission for Rehabilitation

Abstract Background Safe medication management is challenging among older adults due to an increased prevalence of multiple chronic diseases often requiring complex multi-drug pharmacotherapy. Poly-pharmacy can increase the risk of non-adherence to medications in home dwelling older adults, reported as ranging from 6 to 55%. During hospital stays older adults may lose control over their medication management due to the shift in responsibilities from patient to healthcare professionals. Self-administration of medication (SAM) can increase patients’ understanding about their medication and promote independence and autonomy in the hospital setting. Methods From January -December 2023, all elective admissions were assessed for inclusion in SAM during their inpatient stay (n-74). An assessment tool, validated for use in the residential care setting was used. The tool, comprising of 17 items assesses the patients experience of self- medication, capability to self-medicate (cognition and function) and knowledge of their medications. Criteria for inclusion in SAM included older adults who self-administered their medication at home prior to admission and assessed as suitable using the assessment tool. Medication reconciliation was undertaken by a pharmacist for all patients prior to commencing SAM. Results 42% of admissions (n=31) were deemed suitable for SAM during their inpatient stay. Mean age 79 years (age range: 68-96 years). Number of medications > 5 medications daily. 90% (n-28) successfully completed SAM throughout their stay with 10% (n-3) reverting to nurse administration due to changes in medication during their inpatient stay Conclusion The use of the assessment tool supported a 90% success rate for SAM in this cohort. Further testing is recommended to evaluate the tool in other in-patient settings. An evaluation of SAM for the prospective of older adults and nursing team is also recommended.

Prevalence and factors related to frailty dwelling home elderly -subjects using a modified SEGA scale: a study in primary care

This was a cross-sectional descriptive study. The primary endpoint was frailty, assessed using the modified SEGA grid. The prevalence of frail and very frail people was jointly estimated at 33%. In multivariate analysis, gender, lifestyle and marital status did not appear to be associated with frailty. However, the IAVL score was associated with frailty OR=0.21 (95% CI 0.06 to 0.68; p=0.009). EVS is also associated with frailty for mild pain OR= 12.12 (95% CI 2.49 to 59.08; p=0.007). Our results independently show the association between IAVL and frailty, with a one-unit increase in IAVL score being less associated with frailty.

Attitude Towards Ageing Among Elderly Population Residing at Selected Old Age Home and Home Dwelling Elderly Population: Comparative Approach

Attitude Towards Ageing Among Elderly Population Residing at Selected Old Age Home and Home Dwelling Elderly Population: Comparative Approach

Improved Medication Adherence of an Elderly Diabetic Patient at a Dwelling Home Using a Pill Dispenser and Personal Health Records.

Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient to take the medications. If the patient misses a dose, a designated contact, such as the patient's child, is alerted. We conducted an experiment monitoring the use of a pill dispenser (Fookkun®) by an older patient. The participant was a 71-year-old woman with diabetes living in a dwelling home. The experiment lasted approximately 6 months. Fookkun® and the prototype data transmitter were installed at the patient's home. Fookkun®'s medication history data are displayed on the electronic medication record book (E-MRB) and the patient's pharmacist checks the patient's medication history on the E-MRB. The Fookkun® was effective in facilitating medication adherence. The pharmacist and the patient's daughter did not need to check the E-MRB because Fookkun® alerted them when the patient missed her medication. We believe that if the medication history data linked between a pill dispenser and an E-MRB can be shared among medical staff, this will contribute to a medical digital transformation in Japan in the future.

S11: Digital Health and Artificial Intelligence (AI) in Psychogeriatrics: Opening Multiple Frontiers

Symposium OverviewOverall Abstract:The past decade has seen an explosion in the growth of technologies in mental health. Particularly, the scaled adoption of virtual care catalyzed by the COVID-19 pandemic has opened up new frontiers in how digital tools can be incorporated into psychiatry. No area of mental health care is as ripe for digital innovation as psychogeriatrics. In this session, an international group of clinicians and researchers will demonstrate how digital health in psychogeriatrics represents multiple cutting edges of innovation.Our symposium will include 4 presentations, that represent original research from the USA, Ecuador, Norway, Kosovo and Australia. We will highlight clinical applications of these digital tools and aligned issues such as improved care access in low- and middle-income countries, the ethics of digital data collection and the potential for creating new liabilities.We will focus on four distinct technologies and applications. Dr. Ipsit Vahia will discuss passive environmental sensing supported by signal processing and artificial intelligence (AI) in guiding treatment decision making, especially in dementia care. His presentation will include discussions on how AI can be incorporated into care while also preserving autonomy. Dr. Kreshnik Hoti will discuss the application of AI on voice-based signals to determine changes in pain levels and psychopathology. His presentation will include research conducted in collaboration between teams based in Australia and Kosovo and through a public-private partnership with a digital health startup. Dr. Ana Trueba will focus on digital interventions, specifically virtual reality (VR). She will present data from two studies, one from McLean hospital In the US, and the other from Ecuador that explore how VR can deliver evidence-based non-pharmacologic interventions. Dr. Bettina Husebø will present data from a project she oversees in Norway. Her talk will discuss how care in nursing homes can be improved by incorporating a range of digital approaches into nursing home care paradigms. A particular focus will be on the relationship between pain and behavior symptoms and dementia among nursing home dwelling older adults.Thus, the symposium will address diagnostics, treatment and systems level care and how New technologies are shaping the evolution of psychogeriatrics worldwide.

A Prospective Intervention Study With 6 Months Follow-up of the Effect of Reablement in Home Dwelling Elderly: Patient-reported and Observed Outcomes

ObjectivesTo investigate the effect of a reablement intervention (a person-centered, interdisciplinary rehabilitation approach) compared with usual care services in home-dwelling elderly experiencing functional declines in activities of daily living. DesignA non-randomized controlled trial comparing a reablement intervention with usual care; outcomes were measured at baseline, after intervention, and at a 6-month from baseline in both groups. SettingMunicipal public health service. ParticipantsSixty-five home-dwelling elderly with functional decline were assigned by the participants home care service zone to a reablement group (n=35), or a usual care group (n=30). The mean participant age was 80±11 years in the reablement group and 78±12 in the usual care group. InterventionThe reablement group received a person-centered and tailored reablement program provided by an interdisciplinary team, consisting of a physiotherapist, an occupational therapist, and a nurse. The usual care group received standard home care services. Main Outcome MeasuresThe dimension “Your health today” from the European Quality of Life-Visual Analog Scale (HRQOL), the patient-specific functional scale for goals in ADL (PSFS), the short physical performance battery (SPPB), and home care services in hours per week. ResultsThere were significant differences over time in favor of the reablement group with between-group effect sizes of Cohen h2=0.36 (P=.001) for HRQOL, h2=0.60 (P=.001) for PSFS, h2=0.30 (P=.001) for SPPB, and h2=0.10 (P=.013) for hours of home care services per week. The within-group effect size for PSFS was h2=0.15 (P=.010) in favor of the reablement group. The mean number of hours of home care services per week was mean 0.38±1.07 (P=.001) in the reablement group and mean 30.38±64.13 (P=.023) in the usual care group. ConclusionsThe participants in the reablement group achieved and maintained better physical function, a higher HRQOL and needed considerably less home care services than the usual care group participants. Thus, reablement appears to be a more beneficial and sustainable approach than the usual care services for the home-dwelling elderly with functional decline.

S9-3 Keep up -groups support fall prevention

Abstract Purpose In Finland one third of home dwelling older adults 70+ fall at least once a year. Falling causes injuries and suffering. The cost of one hip fracture is about 30 000 € on the first treatment year. Balance and functional training is effective in preventing falls. Half of hip fractures can be prevented by exercising. Project or policy description Development: Age Institute is a partner in Age-friendly South Karelia project coordinated by Wellbeing Services County of South Karelia. The project acts through a network with municipalities, NGO’s, congregations, and older people councils. Preventing falls became an important goal of project since the number of hip fractures was increasing and higher than the average in Finland. Several actions were developed: educating professionals, giving information to older people, and improving exercise groups. Implementation ‘Keep up’ exercise group for older adults with increased risk of falling was implemented in every municipality (9) of the county. The risk of falling was assessed using a screening questionnaire in health care centers or in events, where participants with high scores were guided to the groups. Municipal sport sector organized the strength and balance training group once a week. The participants were encouraged to do home exercise weekly. The groups also included discussion and tasks about falls prevention. Themes were e.g. nutrition, fear of falling, medication and safe environment. Age Institute made the material for the group. Evaluation SPPB test was made in the beginning and in the end of the 10 weeks training period. Majority of participants improved their physical performance. According to a questionnaire the participants perceived mostly good or strong benefits. Especially mood, strength, and knowledge of preventing falls improved. After the training period the participants were guided to continue exercising. Dissemination The municipalities continue to organize Keep up groups. The good practice will be disseminated to other municipalities and counties involved in Strength in Old Age Programme. Conclusions With multisectoral co-operation you can find older adults with increased risk of falling and guide them to exercise group. Strength and balance training combined with getting more knowledge is a feasible good practice.

Predictors of Daily Utilization of Long-Lasting Insecticidal Nets for Malaria Prevention in Pregnancy among Antenatal Care Recipients in Southern Nigeria

Malaria remains a significant public health concern, particularly among pregnant women in sub-Saharan Africa. Long Lasting Insecticidal Nets (LLINs) have been recognized as an effective preventive measure against malaria transmission. However, the utilization of LLINs among pregnant women remains suboptimal. This study aimed to assess the level of daily LLIN utilization and identify its predictors among pregnant women receiving antenatal care in a tertiary healthcare centre in Southern Nigeria. A cross-sectional study was conducted among antenatal recipients at the University of Uyo Teaching Hospital in Uyo, AkwaIbom State. A total of 323 respondents were recruited for the study. Data were collected using a pre-tested semi-structured questionnaire. Multivariable logistic regression analyses were performed to identify predictors of daily LLIN usage. One hundred and twenty seven (39.3%) of the respondents had ever slept inside a LLIN during the index pregnancy, while 22.6% reported daily usage. LLIN ownership was reported by 47.7% of the respondents, highlighting a discrepancy between ownership and consistent use. Predictors of daily LLIN usage included LLIN ownership (aOR 3.83, 95% CI 1.95-7.48), absence of discomfort during LLIN use (aOR 9.33,95%CI 4.32-20.17), non-use of other malaria preventive measures (aOR 3.7,95% CI 11.51-8.93) and presence of mosquitoes in home dwelling (aOR 3.56 95%CI 1.35-9.37). Health education campaigns should emphasize the benefits of daily LLIN usage during pregnancy. Policy interventions are warranted to increase LLIN distribution and availability to pregnant women through antenatal care clinics.

Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs

COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients’ preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.

Geographic Variations in Human Mobility Patterns during the First Six Months of the COVID-19 Pandemic in California.

Human mobility influenced the spread of the COVID-19 virus, as revealed by the high spatiotemporal granularity location service data gathered from smart devices. We conducted time series clustering analysis to delineate the relationships between human mobility patterns (HMPs) and their social determinants in California (CA) using aggregated smart device tracking data from SafeGraph. We first identified four types of temporal patterns for five human mobility indicator changes by applying dynamic-time-warping self-organizing map clustering methods. We then performed an analysis of variance and linear discriminant analysis on the HMPs with 17 social, economic, and demographic variables. Asians, children under five, adults over 65, and individuals living below the poverty line were found to be among the top contributors to the HMPs, including the HMP with a significant increase in the median home dwelling time and the HMP with emerging weekly patterns in full-time and part-time work devices. Our findings show that the CA shelter-in-place policy had varying impacts on HMPs, with socially disadvantaged places showing less compliance. The HMPs may help practitioners to anticipate the efficacy of non-pharmaceutical interventions on cases and deaths in pandemics.

Prevalence and influencing factors of wheeze and asthma among preschool children in Urumqi city: a cross-sectional survey

To investigate the prevalence and indoor environmental influencing factors of wheeze and asthma among preschool children in Urumqi, Xinjiang, China to provide a strong basis for prevention and control. In August 2019, a cross-sectional study involving 8153 preschool children was conducted in 60 kindergartens in Urumqi. The ALLHOME-2 questionnaire was used for childhood wheeze and asthma survey, and the dampness in buildings and health (DBH) questionnaire was used for the childhood home dwelling and living environment survey. Multivariate unconditional logistic regression was then used to analyze the potential influencing factors of childhood asthma and wheeze. The prevalence of wheeze and asthma in children was 4.7% and 2.0%, respectively. Multivariate unconditional logistic regression results suggested that ethnicity other than the Han Chinese (odds ratio (OR) 1.39, 95% confidence interval (CI) 1.05–1.84), caesarean section (OR 1.24, 95% CI 1.00–1.53), family history of asthma (OR 5.00, 95% CI 3.36–7.44), carpet or floor bedding at home (OR 1.40, 95% CI 1.05–1.87), purchasing new furniture in the mother’s residence during pregnancy (OR 1.58, 95% CI 1.06–2.36), pet keeping in the residence at aged 0–1 year (OR 1.55, 95% CI 1.13–2.13), passive smoking by child in the current residence (OR 1.35, 95% CI 1.01–1.80), and having mould or hygroma in the child's residence at aged 0–1 year (OR 1.72, 95% CI 1.12–2.64) were risk factors for wheeze. In addition, Girls (OR 0.73, 95% CI 0.59–0.90) was a protective factor for wheeze. Caesarean section (OR 1.46, 95% CI 1.06–2.00), family history of asthma (OR 7.06, 95% CI 4.33–11.53), carpet or floor bedding at home (OR 2.20, 95% CI 1.50–3.23), and pet keeping in the residence at aged 0–1 year (OR 1.64, 95% CI 1.04–1.83) were risk factors for asthma, whereas Girls (OR 0.58, 95% CI 0.42–0.80) was a protective factor for asthma. This survey indicates that the purchase of new furniture, the placement of carpet or floor bedding in the child's residence, the pets keeping, room dampness or moldy phenomena, and passive smoking may all contribute to an elevated risk of wheeze or asthma in children.

Causal relationship between health insurance and overall health status of children: Insights from Pakistan.

Evaluating the impact of health insurance always remains a methodologically challenging endeavor due to the absence of sample randomization. This paper evaluates the impact of health insurance on the health status of children in Pakistan using the data of the Multiple Indicator Cluster Survey (MICS) for Punjab, Pakistan, from 2017 to 2018. The study adopted the propensity score matching (PSM) method to address the sample selection bias. The sample is matched on potential covariates such as mother characteristics (education level), household head characteristics (gender, age, and education), and other household conditions (such as home dwelling, internet access, wealth index, migration member, number of children residing in the home, as child illness, etc.). The findings revealed that children with insurance have considerably better health than non-insured, at a 1% significance level. The results confirm that health insurance is not a luxury but a need that improves children's overall health. In this regard, governments should enhance and expand programs related to health insurance, especially for children. Health insurance programs will not only help poor people but also improve the overall infrastructure of health services in the country.

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study

BackgroundHome-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support.MethodsUsing an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table.ResultsOf the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care.ConclusionsGiven the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.

S05-1 Online tool to stimulate physical activity for older people with dementia - development and dissemination

Physical activity (PA) stimulates physical health, quality of life, and potentially cognition in people with dementia. However, home dwelling older people with dementia are in general less active than peers. For those attending daycare, the amount of physical activity is highly dependent on the centre's policy. For those without daycare, municipalities are responsible for support but generally there is no attention to PA for this target group. Professionals and volunteers in day care centers, and informal caregivers lack awareness and knowledge to support the people with dementia. Figures on users of other online information on PA show that video's and practical information are highly rated.As part of a research consortium with 4 scientific partners, we were funded for dissemination of research outcomes to practice and policy. We therefore decided to build an online tool with easy to understand instruction movies and background information on theme's like strong legs and physical activity friendly layout of spaces. Human movement scientists provided the technical exercise information. We tested the information on user-friendliness among professionals. The instrument was launched in the week of World Alzheimer's day 2019. The tool has been viewed often since then. We will present development and dissemination of the tool and will discuss ongoing optimization.

Comparison handgrip strength, gait speed, activity of daily living between community dwelling and nursing home in population- base elderly at Bali

Background: Age, muscle strength, gait speed, functional activity have correlation to another, because if have decrease of result, it will increase risk to making geriatric syndrome including sarcopenia and frailty, and giving high risk morbidity and mortality elderly, based on that we will compare handgrip strength, gait speed and activity of daily living in elderly people in population in community with population in nursing home because of that has been little explored this problem. Objective: This study aimed to investigate the comparison handgrip strength, gait speed and activity of daily living between community and nursing home in population-based elderly. Methods: This is an observational analytic study, data we collect from cross sectional study in community and nursing home. Handgrip strength, gait speed and activity of daily living score were recorded to statistical program; p<0.05 was considered as statistically significant. Results: Sixty two geriatric sample from community and nursing home. We use Mann-Whitney method. There is significant difference of handgrip strength, gait speed and activity of daily living between elderly living in community and elderly living in nursing home. Handgrip strength (17.8+6.6 VS 14.2+6.1; P=0.008), gait speed (0.53 ± 0.187 VS 0.36 ± 0.07; P=0.000) and activity of daily living (19.1 ± 1.8 VS 12.1± 4.6; P=0.000) Conclusion: Our study showed decrease handgrip strength, gait speed and activity of daily living in nursing home versus community dwelling and this can make increase risk severe morbidity and mortality in elderly at Bali.

Use of dental implants among older adults of two southern Brazilian cities: A population-based cross-sectional study.

To assess the prevalence and associated factors with use of dental implants among older adults. This cross-sectional study was performed with home dwelling older adults from the cities Cruz Alta and Veranópolis, Brazil. The main outcome was obtained by a clinical oral examination, considering those with at least one dental implant. Independent variables were collected by a structured questionnaire. Crude and adjusted analysis was performed by Poisson regression with robust variance estimation; results are presented in prevalence ratio (PR) and 95% confidence interval. It was included 569 participants. The overall prevalence of using at least one dental implant was 16.7%. Higher PR for the use of dental implants was observed in white individuals (PR:5.147; 95% CI:2.033-3.034), in those with at least medium income (PR:3.202; 95% CI:1.196-5.572) and in those with access to dental care in the last 12 months (RP:1.595; 95% CI:1.087-2.340). Older adults with a medium level of education (RP:0.484; 95% CI:0.240-0.978) and those that did not use dental floss (RP:0.627; 95% CI:0.240-0.978) demonstrated a significantly lower PR for use of dental implants. A substantial prevalence of use of dental implants was observed among older adults. In addition, white ones, those with a better financial situation and users of dental floss presented higher use of dental implants.

Household poverty levels in Namibia and their associated sociodemographic factors: An empirical investigation of the 2015/16 Namibia household income and expenditure survey

Despite the intervention strategies that have been put in place to fight poverty, Namibia continues to experience prevalence of poverty with large numbers of households still living in poverty conditions and unable to afford the minimum daily essentials for a decent life. In this quantitative cross-sectional study design, the impact of sociodemographic characteristics of households on their poverty levels was statistically analysed using an ordered probit regression on data from the 2015/16 Namibia household income and expenditure survey. Results showed that sociodemographic characteristics such as the types of household dwelling unit, highest education attainment of the head of household, household main language, household tenure and household main source of income had a significant impact on the household's poverty levels. Households living in a mobile home dwelling unit, whose heads had secondary education as their highest educational attainment as well as households that were mortgaged and whose main source of income were from other sources were less likely to be severely household poor and more likely to be household poor. Furthermore, households living in a singlequarters dwelling unit and whose main language were Setswana were more likely to be severely household poor and less likely to be household poor. It is therefore recommended that the Namibian government and policy makers put more efforts in improving the sociodemographic characteristics of households, particularly those living in a single quarter dwelling unit and whose main language were Setswana.

"This Is Not Our Disease": A Qualitative Study of Influencers of COVID-19 Preventive Behaviours in Nguenyyiel Refugee Camp (Gambella, Ethiopia).

The COVID-19 pandemic has infected more than 263 million people and claimed the lives of over 5 million people worldwide. Refugees living in camp settings are particularly vulnerable to infection because of the difficulty implementing preventive measures and lack of medical resources. However, very little is known about the factors that influence the behavioural response of refugees towards COVID-19. There is an urgent need for field evidence to inform the design and implementation of a robust social and behaviour change communication strategy to respond to the threat posed by COVID-19 in humanitarian settings. This study examines factors influencing COVID-19-related behavioural decisions in the Nguenyyiel refugee camp located in Gambella, Ethiopia using data collected from focus group discussions and key informant interviews in September 2020. The evidence suggests that while a number of factors have been facilitating the adoption of COVID-19 prevention measures, including good general knowledge about the virus and the necessary preventive strategies and the active engagement by community leaders and non-governmental organisations, important structural and cultural factors have hindered the uptake of COVID-19 prevention measures. These include: difficultly staying at home to minimise physical contact; overcrowding in the camp and within home dwellings; a lack of hand sanitizers and masks and of funds to purchase these; inconsistent use of facemasks when available; COVID-19 denial and misconceptions about the disease, and other cultural beliefs and habits. Overall, the study found that refugees perceived COVID-19 to pose a low threat (susceptibility and severity) and had mixed beliefs about the efficacy of preventive behaviours. This study identified gaps in the existing information education and communication strategy, including a lack of consistency, inadequate messaging, and a limited use of communication channels. While awareness of COVID-19 is a necessary first step, it is not sufficient to increase adoption of prevention measures in this setting. The current communication strategy should move beyond awareness raising and emphasise the threat posed by COVID-19 especially among the most vulnerable members of the camp population. This should be accompanied by increased community support and attention to other barriers and incentives to preventive behaviours.

Physical Activity Levels among Community Dwelling and Care Home Dwelling Elderly Population

Background: Ageing is frequently associated with a decrease in physical activity and consequently adecline in physical fitness. Physical activity is associated with psychological health, and a large numberof studies have begun to document preventive effects for depression or neurodegenerative diseases.However, health-related quality of life is composed not only of a physical or cognitive functioningdomain, but also by the feelings of well-being.Objective: To determine the difference in physical activity levels among community dwelling and carehome dwelling elderly population.Method: 100 healthy elderly subjects aged 60 to 85 years were included in the study, out of which 50subjects were recruited from community and 50 subjects were recruited from care homes. Physicalactivity level of all the subjects was assessed using Frenchay Activity Index (FAI).Results: Krushkal Wallis ANOVA test was carried out to compare the values between the groups forFrenchay Activity Index (FAI) and it was found to be statistically significant (p<0.05).Conclusion: Based on the results of the study, it can be concludedthat the physical activity levels ofthe elderly population in community dwelling was significantly better than those who were living incare homes.

A timed activity protocol to address sleep-wake disorders in home dwelling persons living with dementia: the healthy patterns clinical trial

BackgroundSleep-wake disorders occur in most persons living with dementia and include late afternoon or evening agitation, irregular sleep-wake rhythms such as daytime hypersomnia, frequent night awakenings, and poor sleep efficiency. Sleep-wake disorders pose a great burden to family caregivers, and are the principal causes of distress, poor quality of life, and institutionalization. Regulating the sleep-wake cycle through the use of light and activity has been shown to alter core clock processes and suggests that a combination of cognitive, physical, and sensory-based activities, delivered at strategic times, may be an effective mechanism through which to reduce sleep-wake disorders.MethodsA definitive Phase III efficacy trial of the Healthy Patterns intervention, a home-based activity intervention designed to improve sleep-wake disorders and quality of life, is being conducted using a randomized two-group parallel design of 200 people living with dementia and their caregivers (dyads). Specific components of this one-month, home-based intervention involve 4 in-home visits and includes: 1) assessing individuals’ functional status and interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in using timed morning, afternoon, and evening activities based on circadian needs across the day. The patient focused outcomes of interest are quality of life, measures of sleep assessed by objective and subjective indicators including actigraphy, subjective sleep quality, and the presence of neuropsychiatric symptoms. Caregiver outcomes of interest are quality of life, burden, confidence using activities, and sleep disruption. Salivary measures of cortisol and melatonin are collected to assess potential intervention mechanisms.DiscussionThe results from the ongoing study will provide fundamental new knowledge regarding the effects of timing activity participation based on diurnal needs and the mechanisms underlying timed interventions which can lead to a structured, replicable treatment protocol for use with this growing population of persons living with dementia.Clinical trial registrationClinicaltrials.gov # NCT03682185 at https://clinicaltrials.gov/; Date of clinical trial registration: 24 September 2018.